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Background: Anatomic graft placement in anterior cruciate ligament (ACL) reconstruction has become the preferred technique for many surgeons. The predictive factors for graft failure in anatomic single-bundle ACL reconstruction are relatively unknown. Purpose: To determine the risk factors for graft failure and the relative importance of those factors in anatomic single-bundle ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: All primary anatomic ACL reconstructions undertaken at a single institution over a 2-year period were evaluated for subjective and objective measures of graft failure. Risk factors evaluated included time since ACL rupture, age, sex, body mass index, intact or deficient medial and lateral meniscus, meniscal repair, hamstring graft size, and femoral and tibial tunnel position as assessed by 3D computed tomography (CT) scan. The significant factors predicting failure and the relative importance of those factors were determined. Results: At a median follow-up of 26 months, 123 patients were available for analysis. Ninety-seven patients underwent postoperative 3D CT for tunnel positions, including all 20 cases with graft failure. The significant predictors of graft failure were medial meniscal deficiency (hazard ratio [HR] 15.1; 95% CI, 4.7-48.5; P < .001), lateral meniscal deficiency (HR 9.9; 95% CI, 3-33; P < .001), shallow nonanatomic femoral tunnel positioning (HR 4.3; 95% CI, 1.6-11.6; P = .004), and younger patient age (HR 0.9; 95% CI, 0.9-1; P = .008). Conclusion: Meniscal deficiency is the most significant factor to predict graft failure in single-bundle anatomic ACL reconstruction. Shallow nonanatomic femoral tunnel positioning and younger patient age are additional risk factors for failure, but their relative importance is less. [ABSTRACT FROM AUTHOR]

The aims of this study were to determine the complexity of surgery required to revise failed unicompartmental knee replacements and to evaluate the outcome following revision. Between 2000 and 2009, 494 cemented Oxford phase 3 medial unicompartmental knee replacements were implanted, with 24 (4.9%) requiring revision (mean age: 63.5 years; 58% male). Mean time to revision was 3.0 years. All cases were revised to a cemented total knee replacement, with primary components used in 67% and revision components in 33%. At a mean follow-up of 3.2 years the median Oxford knee score was 333% with one knee requiring re-revision (5-year survival 933%). Most failed unicompartmental knee replacements could be revised without the need for stemmed implants, augmentation, or bone allograft. When bone loss occured it was commonly on the tibial side. Good functional outcome for the revised unicompartmental knee replacement was achieved and was comparable to primary knee replacement.

The primary aim of this retrospective study was to determine the medium-term survival of autologous osteochondral grafts (mosaicplasty) in the knee. The secondary aims were to evaluate any reason for failure, and to ascertain if age, gender, BMI, previous or associated knee surgery, site or size of the osteochondral graft had any influence on outcome. Fifty-five patients undergoing an autologous osteochondral graft procedure between 1999 and 2008 were evaluated, with a mean follow-up of 5.9 years (range 0.5 to 10.5). Loosening, graft degeneration or subsequent surgery in the form of arthroplasty, revision autologous osteochondral graft or any other osteochondral procedure, and an Oxford knee score above 49.7 (see text) were considered as failure. Kaplan-Meier analysis demonstrated an 87.5% survival at 8 years (95% CI 72% to 97%). The mean Oxford score at follow-up was 163% (95% CI 10.6% to 22.1%) at follow-up. Two of 6 failures occurred in patients with varus malalignment. Linear regression analysis demonstrated an improved outcome in Oxford knee score in younger patients. Gender, BMI, previous or associated knee surgery, site and size of the graft had no influence on outcome. The authors consider autologous osteochondral grafting as a reliable method of treatment in the medium-term for young patients with small contained articular cartilage lesions up to 4 cm2. Careful attention should be paid to the mechanical axis (varus) prior to grafting. Long-term studies are necessary.